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Individual

MIRIAM K. HENDRICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.D.

Contact information

Practice address
875 W FARIS RD, GREENVILLE, SC 29605-4254
(864) 455-4003
Mailing address
255 ENTERPRISE BLVD, SUITE 250, GREENVILLE, SC 29615-6300
(864) 454-0888
(864) 454-1130

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
537217
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00021522
MEDICARE RAILROAD ID
SC
Enumeration date
01/29/2007
Last updated
07/08/2007
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